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HomeMy WebLinkAbout13983 (27) CITY OF DIAMOND BAR --- ----- DEPARTMENT OF COMMUATITY dc DEVELOPMENT SERVICES 21660 E.Copley Drive Suiu 190 (909)860-3195 Fax(909)861-3117 PRESS ���� BUQ.DING PERMIT APPLICATION , FIRMLY � ADDRESS Z'��� �� ��1� �� �PP�ICATIO PERMIT P/C ' p DATE NUMBER x ISSUE TYPE OCC � APN LOT TRACT �s�� DATE CONST. GROUP S OWNER k��� ADDRESS � ZONING SEfBACKS � CITY I� � O IP ��TEL. �r("�� FRONT RW ❑ APPUCANT �1ta��.C�1�4�� TEL._�_ AEAR ❑ SIDEISI�E STREET RW ❑ CONTRACTOR ' � ' iv SIDE ❑ g ADDRF�S �� r� PROPOSED USE cirv �`i�� �- Z�P �-r • TEL. "� - � DESIQNER � rt.f�.�vtw.1-K !S�(�o - N ADDRESS � t t.d'A- d4i�� 1 '���R' � I UNITS 0. STORIES B DROOMS � CITV E'4'��^13� ZIP 1'�L. m DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUItDER DECLARATION gFq/ADDiAEM O I NEREBY AFFlRM IMDER iENALTY OF PERNRY TMAT�M1 E%EMiT FRON TME CONTRACTORS ll• („g�gaq/C91p0A CENSEUWFORTHEFOLLOWNUqEA30N�5EC.7051.6BU51NE53ANOPROFE551ON5CO0E:FNYq7YOR (n COUNTrWFi1GlREWIiIESAPER4tRT000N5lRUCT,ALTER,IMPNOYE,DEYOI,ISH,011REPA�RIWYSTRUG : W p`tio/�eck 7U11E PRIOR TO RB ISSUANCE.AL50 REQUIRES THE MPLIC�WT FOR StICH PERAtlT TO FILE A SIGNEO STATEYENT TH1IT IIE Oq SHE IS LICENSED PURSUANT TO hIE GpOV1510N3 OF TiE CONTRACTORS lb CENSE LAW(CNAPiEA Y�COMAIENCWO YVITN SGCTpN 700a)OF DINSION 7 OF THE 6VSINE45 ANO PRO- LL PooUSpe � fE6510N50DDE�ORTHATHEORSHEISEXEMMTHEREFROMANDTHEBA5ISFORTHEALIEGEDEXEMR (� TION.ANYVIOLATqNOF6[CTqN7W1.6BYANYAPPLCAfVTPoRApERMRSUBJECTSiHEAPPIIGANTTO Z Re-Roof F ACMLPENAL7YOFNOTMORETIVWFIVENUNCRED�OL1ARSpsoo).): � OL���EROFTNEPiiDPERTt,ORMYEMPI.0YEE9WITHWAGESASTHEIR50LECOtAPEN5A7)ON, � (�`pmmBlC181 - WILL QO TFIE WORN,AND THE STRUCTURE IS NOT MITENDEO Oi1 OFFERE�FOR SALE(SEC.7a.1,BUSI� - J NESS M�PROFESSIONS COOE:THE CONTRACTORS LICENSE UW UOES NOT APVLY TO AN OWNER OF ? . � �NOPEAIYNM10611L�SORYPRGVE57HEREON,AIAWIqDOE55l1CNN1DR1(MINSEIFdiNER5ELF011 Q TIq10UGHNISORNEROWNEA1PlAYEES.►ROVIOEDT/UTSUCFIIMPpOVEMENTSARENOTIN'fEN�EpOR C� �Z� OFFFAmFORSAI.EIF,HOWEYERT�EBUILDINOOqMPROVEMEM139O1lIWIhpNONEY6AROFCOMPLE-: Z TqN,TiE OWNER-0UILDER NALL fUVE iME BUR�EN OF PROVINO TF1A7 HE OF SNE Oq HOT BUItD OII = MPRWEFORTNEPUNPOSEOF�AL�. . ' � ❑I.h50YMEROF7HEPROPERfY,AME7(CLIISIVEUICONTMCTINOYYITMLJCENSEDOONTMCTpiS TO CONSTIIUCT iHE PRWECT(SEC,704t,BUSINESS IWO PHOFESSIONS CODE:TNE CpN7R�C70qS LI- V81118t ADJ.AREA CEN9E lMN DOE9 NOTAPPI,.Y TO NI ONMER OF A PROPERTY WNO BUIIDS OR iA1PROVES THEREaN,AND YM1pCONTRACTSiORSUCHVR0.1ECT3`MTNAOONTHACTORISIUCENSEDPURSUANTTOTHFCONTRhG � QUANTITY DESCRIPTION FEE � fONs IICEN3E L11W.). � ` Q ❑1 AM E%EMpf UNDER 6EC. B.i P.C.FOR h11S HEASDN � q 3 � �= �ATE OWNER � Z W ��( LICENSED CONTRACTORS DECLARATION � � 2 IIIEREBYAFFIRIAUNDERPENlLLTVOFPERRIPVTINTIAMLICENSE�UNDERPFi�VI510N80FCHAPTER � �. � � ��COMMENqNO WITH SECTqN 1a00)OF ONISION 70F TNE B�SMESS AN�PROFESSqNS CO�E,IWD z YY UCQlSE 16 Nl FULL FOfiC AND EFFECT. � �^ �� LICENSE CLASS LIC.NO. '"- �q � �� � � � � MTE���CONTRACTOR�,���� a � . _.. ...+.�Yi;,6,,r.. >`u'� = WORKERS'COMPENSATION DECIAAATION . ¢ �+�_i�_ � IMEREBYI�FFIW.iUlAERPENALTYOFPERIURYONEOF7HEFOLLOWINODECURA710N5: �' Z � � �IHAVEANDN/ILLM.VNTAINACERTIFICATEOFCONSENTTOSELF�INSL'REFORNpRKicRS' � �, z • � � � • OOAiPENSATION,ASPHOVIOEDBYSECTION970oOFTHEUBORCOOE,FOHTHEPERFORMANCE ��U Q Of TME WORK PoR WNlqi TYNS PERMIT IS ISSl1ED. � . . _IHAYEANDMIILL_IANNfAINWORNEAS'COMPENSATIONINSURANCE.ASRG�IIIRE�BY6ECTION'� e O� Q 9�o00F Tf1E LMIOR OODE,FOR h1E PEHFORMAIVCE OFTHE WOHK FOR WHICH THIS PERMIT IS , ISSUED.MY IMDHKEHS'COMPEN9ATION INSVRANCE CMRIEH AND pOLICY NUMBER ME: �R�FIQN � ^ � CAqqIER SMr'.TI1..� �""�� ,` � PLAN REVIEW l � CJ� � VOLICYIAIMBEF O y LFs q� ��T OO� T��� . . . . . , Q � (nwss[t�t�w�r+orsEaonm�rmaFnEaEauarsr�aa�runn�oocu�uLspi��aq�Ess� PLUMBING Z �CERTIFY TiAT W 7HE PERFORMANCE OF THE WORK FOR WMICM TMIS VER�IIT IS ISSUED,1 MECHANICAL SWLLL NOi EMPLOY ANY GENSON W ANY MANNER SO AS TD BEfAME SUBJECT 70 TFIE y WORKERS'COMPEN5ATION LAV/S OF GLLIFORNIA,AN�AOREE TN�T IF I SHWLD BEGOME �It FEE �.�—�-�- SUBJECTTOTHEWORKERS'COMPENSATIONP ISION3 ECTION]70oOF7}iEUBOR � / {�� O �cfa�oe�.i�+Q+uLQcomHwin+coMaivvnn� rnovis� ISSUANCE � latl p DATE:__(1 s 1_I_2— APPLICANT. -.� . � � � , � , � ENE P/C WARNIN�:FAILURE TO5ECUHE YIOflNERS'COMPENSATION COVERA�E IS UNUWFUI,M10 SHAL�BE � SUBIECTMIEMPLOYEHTOCRIMIN�I.GENALTIESANDCIVtLFINESUPTOONEHUN�REOhKri1SAN0 ' ENERGYPERMIT DOUAFiS(it00,000),IN PODIiION TD 7HE COS7 OF CAMPENSATION,DAMAGES AS�qOVIDED FOR IN � SECTIDN�TO!OF 1HE LFBOR CODE,INTEREST,ANDAT70iWEV'S FEE6. RETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEREBV AFFIRIA UNDER OENALTY OF VERJUPV THATTHERE IS A CONSTRUCTION LEN�ING Af�ENCY FOR TNE PEFPDRMANCE OF THE WORK FOR WHILH THIS 7ERAlIT IS ISSUED(SEG 9097,CIV.G�. , W �� LENDER'SNMIE�� . � LENDER'SADURESS f � W ICER7IFYTHATIIUVEFEADh11S11PVLIC1.Tlf)NANDSTATETUT7FIEABOVEINFOpMATpNISCAFRECT. TOTAL FEES . � IAOREETOCOMPLYWI7HALLCITYAN�COUNTYORDINMlCESANDSTATEUW6RELATWGIDBVILDING � CONSTRUCTION,ANDHEREBVAUTFiORRERFPRESEMATNE50FTHISCOUNTYTOEMERUPONTFVE ABOVEaAENTpNEO Vi00PERTY FOR INSPEGTqN PURPOSES. COMMENTS � �� e ti �� � _ O° vEwainee r+ �rrn � Q `�' � � � �,�f (n SIONATUR OF YERIAIT7EE : /_� �ATE � RECPT.NO. � PAID BY � �VALIDATION WHITE-0eperlmenl Capy,VELLOW—Financo Copy,PINK—Assessw Copy,GOLDENROo--Fle Copy,GREEN—Applicant'a Copy . . 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